ADD AND/OR REMOVE DEPENDENTS

OMB Approved No. 2900-0043 Respondent Burden: 30 minutes Expiration Date: 08/31/2025
ADD AND/OR REMOVE DEPENDENTS
INSTRUCTIONS: Make sure you sign and date this form in Items 26A and 26B. Note: Unless the claimant is the veteran's surviving spouse or a designated "alternate signer", the veteran must sign in Item 26A. When you have completed this form, you can mail it to the address shown at the bottom of Page 2. If you prefer you may complete and submit the form online at www.va.gov.
SECTION I: VETERAN/CLAIMANT'S IDENTIFICATION INFORMATION

(Note: Completion of this section is REQUIRED to process your request; any omission may delay processing)
NOTE: You may complete the form online or by hand. If completed by hand, print the information requested in ink, neatly and legibly to help expedite processing of the form.
1. VETERAN'S FIRST NAME
1. VETERAN'S MIDDLE INITIAL
1. VETERAN'S LAST NAME
2. VETERAN'S SOCIAL SECURITY NUMBER
3. VA FILE NUMBER (If known)
4. VETERAN'S DATE OF BIRTH (MM DD YYYY)

MonthDayYear
Date

Section I Continued

Complete the claimant-related questions only if you are filling out this form on behalf of the veteran, and you are not the veteran yourself.
5. CLAIMANT'S FIRST NAME (If other than veteran)
5. CLAIMANT'S MIDDLE INITIAL
5. CLAIMANT'S LAST NAME
6. CLAIMANT'S SOCIAL SECURITY NUMBER
7. VETERAN'S SERVICE NUMBER (If applicable)
8. TELEPHONE NUMBER (Incl. Area Code)*
8. INTERNATIONAL NUMBER (If applicable)

Section I Continued
9. Do you want the VA to email you correspondence involving your claim?

I agree to receive electronic correspondence from VA in regards to my claim.
9. E-MAIL ADDRESS
10. MAILING ADDRESS OF VETERAN/CLAIMANT (Number and Street or Rural Route, P.O. Box)
10. APT./UNIT NUMBER
10. CITY
10. STATE
10. COUNTRY
10. ZIP CODE/POSTAL CODE

SECTION II: INFORMATION NEEDED TO ADD SPOUSE
11A. SPOUSE'S CURRENT LEGAL FIRST NAME
11A. SPOUSE'S CURRENT LEGAL MIDDLE INITIAL
11A. SPOUSE'S CURRENT LEGAL LAST NAME
11C. SPOUSE'S SOCIAL SECURITY NUMBER (SSN) (If your spouse does not have an SSN, explain why in Section IX, Item 25, Remarks)
11E. PLACE OF MARRIAGE (City and State, County and State, or City and Country)
Country
11F. HOW WERE YOU MARRIED? (Check one)

RELIGIOUS CEREMONY (i.e. Minister, Priest, Rabbi, etc
TRIBAL
PROXY
CIVIL CEREMONY (i.e. Justice of the Peace) OTHER (Explain)

12A. IS YOUR SPOUSE ALSO A VETERAN?

YES (If "YES," complete Items 12B and 12C)
12B. SPOUSE'S VA FILE NUMBER (If applicable)
12C. SPOUSE'S SERVICE NUMBER (If applicable)
NOTE:If you are a veteran that VA is paying additional benefits for a stepchild and you no longer live with the stepchild's biological or adoptive parent, complete Section V. 13B. REASON FOR SEPARATION (For example, marital problems, job requirements, health, etc

NO (If "NO," complete Items 13B and 13C)
13B. REASON FOR SEPARATION (For example, marital problems, job requirements, health, etc.)
13C. CURRENT MAILING ADDRESS OF SPOUSE (Number and Street or Rural Route, P.O. Box, City, State, ZIP Code and Country) No. &
Street
Apt./Unit Number
City
State/Province
Country
ZIP Code/Postal Code
NOTE: You must provide complete information about your prior marriages and your current spouse's prior marriages.

14. VETERAN/CLAIMANT'S PREVIOUS MARITAL INFORMATION

(If no prior marriages, this section may be left blank)
14A. (1) TO WHOM MARRIED (First, Middle Initial, Last Name)
14A. (2) DATE AND PLACE OF MARRIAGE
Country
14A. (3) REASON FOR TERMINATION

14A. (4) DATE AND PLACE MARRIAGE TERMINATED (MM-DD-YYYY)
City or County
Country
14B. (1) TO WHOM MARRIED (First, Middle Initial, Last Name)
Name)
14B. (2) DATE AND PLACE OF MARRIAGE
(MM-DD-YYYY)
State/Province
Country
14B. (3) REASON FOR TERMINATION

14B. (4) DATE AND PLACE MARRIAGE TERMINATED (MM-DD-YYYY)
State/Province
Country
14C. (1) TO WHOM MARRIED (First, Middle Initial, Last Name)
14C. (2) DATE AND PLACE OF MARRIAGE
(MM-DD-YYYY)
Country
14C. (3) REASON FOR TERMINATION

14C. (4) DATE AND PLACE MARRIAGE TERMINATED (MM-DD-YYYY)
State/Province
Country
14D. (1) TO WHOM MARRIED (First, Middle Initial, Last Name)
14D. (2) DATE AND PLACE OF MARRIAGE
(MM-DD-YYYY)
Country
14D. (3) REASON FOR TERMINATION

14D. (4) DATE AND PLACE MARRIAGE TERMINATED (MM-DD-YYYY)
15. CURRENT SPOUSE'S PREVIOUS MARITAL INFORMATION

(If no prior marriages, this section may be left blank)
15A. (1) TO WHOM MARRIED (First, Middle Initial, Last Name)
15A. (2) DATE AND PLACE OF MARRIAGE
(MM-DD-YYYY)
State/Province
Country
15A. (3) REASON FOR TERMINATION

15A. (4) DATE AND PLACE MARRIAGE TERMINATED (MM-DD-YYYY)
Country
15B. (1) TO WHOM MARRIED (First, Middle Initial, Last Name)
15B. (2) DATE AND PLACE OF MARRIAGE
(MM-DD-YYYY)
State/Province
Country
15B. (3) REASON FOR TERMINATION

15B. (4) DATE AND PLACE MARRIAGE TERMINATED (MM-DD-YYYY)
State/Province
Country
15C. (1) TO WHOM MARRIED (First, Middle Initial, Last Name)
15C. (2) DATE AND PLACE OF MARRIAGE
(MM-DD-YYYY)
State/Province
Country
15C. (3) REASON FOR TERMINATION

15C. (4) DATE AND PLACE MARRIAGE TERMINATED (MM-DD-YYYY)
Country
15D. (1) TO WHOM MARRIED (First, Middle Initial, Last Name)
15D. (2) DATE AND PLACE OF MARRIAGE
(MM-DD-YYYY)
State/Province
Country
15D. (3) REASON FOR TERMINATION

15D. (4) DATE AND PLACE MARRIAGE TERMINATED (MM-DD-YYYY)
SECTION III: INFORMATION NEEDED TO ADD CHILD(REN)
(If claiming more than four children, fill out addendum (Page 15) and submit with application)
16A. NAME OF FIRST CHILD TO ADD (First, Middle Initial, Last)
16B. SOCIAL SECURITY NUMBER
16C. DATE OF BIRTH (MM DD YYYY)

MonthDayYear
Date
16D. PLACE OF BIRTH (Provide City and State, County and State, or City and Country)
Country
16E. IF THE CHILD DOES NOT LIVE WITH THE CLAIMANT PROVIDE NAME OF PERSON THE CHILD RESIDES WITH
16F. IF THE CHILD DOES NOT LIVE WITH THE CLAIMANT, PROVIDE COMPLETE PHYSICAL ADDRESS WHERE CHILD RESIDES
City
Country
16G. CHILD STATUS (Check all that apply) 18-23 YEARS OLD AND IN SCHOOL (If checked, fill out VA Form 21-674) CHILD PREVIOUSLY MARRIED (If checked, provide the date marriage ended and how the marriage ended in Item 16H)
BIOLOGICAL
CHILD PERMANENTLY INCAPABLE OF SELF-SUPPORT
STEPCHILD (If checked, complete Item 16I)

16H. HOW AND WHEN MARRIAGE ENDED
DATE (MM-DD-YYYY)
16I. IF YOU CHECKED "STEPCHILD" IN ITEM 16G, IS STEPCHILD THE BIOLOGICAL CHILD OF YOUR SPOUSE?

YES (If "Yes," provide the date the child entered veteran's household) DATE (MM-DD-YYYY)
17A. NAME OF SECOND CHILD TO ADD (First, Middle Initial, Last)
17B. SOCIAL SECURITY NUMBER
17C. DATE OF BIRTH (MM DD YYYY)

MonthDayYear
Date
17D. PLACE OF BIRTH (Provide City and State, County and State, or City and Country)
State/Province
Country
17E. IF THE CHILD DOES NOT LIVE WITH THE CLAIMANT PROVIDE NAME OF PERSON THE CHILD RESIDES WITH
17F. IF THE CHILD DOES NOT LIVE WITH THE CLAIMANT, PROVIDE COMPLETE PHYSICAL ADDRESS WHERE CHILD RESIDES
City
Country
17G. CHILD STATUS (Check all that apply) 18-23 YEARS OLD AND IN SCHOOL (If checked, fill out VA Form 21-674) CHILD PREVIOUSLY MARRIED (If checked, provide the date marriage ended and how the marriage ended in Item 17H)
CHILD PERMANENTLY INCAPABLE OF SELF-SUPPORT
STEPCHILD (If checked, complete Item 17I)

17H. HOW AND WHEN MARRIAGE ENDED
DATE (MM-DD-YYYY)
171.IF YOU CHECKED "STEPCHILD" IN ITEM 17G, IS STEPCHILD THE BIOLOGICAL CHILD OF YOUR SPOUSE?

YES (If "Yes," provide the date the child entered veteran's household) DATE (MM-DD-YYYY)
SECTION III: INFORMATION NEEDED TO ADD CHILD(REN) (Continued) (If claiming more than four children, fill out addendum (Page 15) and submit with application)
18A. NAME OF THIRD CHILD TO ADD (First, Middle Initial, Last)
18B. SOCIAL SECURITY NUMBER
18C. DATE OF BIRTH (MM DD YYYY)

MonthDayYear
Date
18D. PLACE OF BIRTH (Provide City and State, County and State, or City and Country)
State/Province
Country
18E. IF THE CHILD DOES NOT LIVE WITH THE CLAIMANT PROVIDE NAME OF PERSON THE CHILD RESIDES WITH
18F. IF THE CHILD DOES NOT LIVE WITH THE CLAIMANT, PROVIDE COMPLETE PHYSICAL ADDRESS WHERE CHILD RESIDES
City
Country
18G. CHILD STATUS (Check all that apply) 18-23 YEARS OLD AND IN SCHOOL (If checked, fill out VA Form 21-674) CHILD PREVIOUSLY MARRIED (If checked, provide the date marriage ended and how the marriage ended in Item 18H)
BIOLOGICAL
ADOPTED
CHILD PERMANENTLY INCAPABLE OF SELF-SUPPORT
STEPCHILD (If checked, complete Item 18I)

18H. HOW AND WHEN MARRIAGE ENDED
DATE (MM-DD-YYYY)
18I.IF YOU CHECKED "STEPCHILD" IN ITEM 18G, IS STEPCHILD THE BIOLOGICAL CHILD OF YOUR SPOUSE?

YES (If "Yes," provide the date the child entered veteran's household) DATE (MM-DD-YYYY)
19A. NAME OF FOURTH CHILD TO ADD (First, Middle Initial, Last)
19B. SOCIAL SECURITY NUMBER
19C. DATE OF BIRTH (MM DD YYYY)

MonthDayYear
Date
19D. PLACE OF BIRTH (Provide City and State, County and State, or City and Country)
State/Province
Country
19E. IF THE CHILD DOES NOT LIVE WITH THE CLAIMANT PROVIDE NAME OF PERSON THE CHILD RESIDES WITH
19F. IF THE CHILD DOES NOT LIVE WITH THE CLAIMANT, PROVIDE COMPLETE PHYSICAL ADDRESS WHERE CHILD RESIDES
Apt./Unit Number
City
Country
19G. CHILD STATUS (Check all that apply) 18-23 YEARS OLD AND IN SCHOOL (If checked, fill out VA Form 21-674) CHILD PREVIOUSLY MARRIED (If checked, provide the date marriage ended and how the marriage ended in Item 19H)
CHILD PERMANENTLY INCAPABLE OF SELF-SUPPORT
STEPCHILD (If checked, complete Item 191)

19H. HOW AND WHEN MARRIAGE ENDED DATE (MM-DD-YYYY)

19I. IF YOU CHECKED "STEPCHILD" IN ITEM 19G, IS STEPCHILD THE BIOLOGICAL CHILD OF YOUR SPOUSE?

YES (If "Yes," provide the date the child entered veteran's household) DATE (MM-DD-YYYY)
SECTION IV: VETERAN REPORTING DIVORCE FROM FORMER SPOUSE
(If you have stepchild(ren), also complete Section V)

NOTE: If marriage ended as an annulment or declared void, use Section IX, Item 25, "Remarks" to explain.
20A. NAME OF FORMER SPOUSE (First, Middle Initial, Last)
20B. PLACE OF DIVORCE (Provide city and state, county and state, or city and country)
State/Province
Country
20C. DATE OF DIVORCE

MonthDayYear
Date
SECTION V: VETERAN/CLAIMANT REPORTING ON STEPCHILD(REN)
21A. (1) DID YOU HAVE A STEPCHILD(REN THAT WAS THE BIOLOGICAL OR ADOPTED CHILD(REN) OF THE FORMER SPOUSE LISTED IN ITEM 20A?

YES (If "YES," list the name(s) of the stepchild(ren) here): NO (If "NO," skip to Section VI) 21A. (2) NAME(S) OF STEPCHILD(REN) (First, Middle Initial, Last)
21A. (2) NAME(S) OF STEPCHILD(REN) (First, Middle Initial, Last)
21B. ARE YOU STILL SUPPORTING YOUR STEPCHILD(REN) LISTED IN ITEM 21A?

YES (If "YES," complete Items 21C through 21L) NO (If "NO," complete Item 21F and then continue to Section VI)
21C. NAME OF STEPCHILD YOU ARE SUPPORTING
21D. IF STEPCHILD DOES NOT LIVE WITH YOU, PROVIDE THE NAME OF PERSON WITH WHOM STEPCHILD RESIDES
21E. IF STEPCHILD DOES NOT LIVE WITH YOU, PROVIDE A COMPLETE ADDRESS
Street
City
Country
21F. DATE STEPCHILD LEFT VETERAN'S HOUSEHOLD (MM-DD-YYYY)
21G. FINANCIAL SUPPORT PROVIDED
21H. NAME OF STEPCHILD YOU ARE SUPPORTING
211. IF STEPCHILD DOES NOT LIVE WITH YOU, PROVIDE THE NAME OF PERSON WITH WHOM STEPCHILD RESIDES
21J. IF STEPCHILD DOES NOT LIVE WITH YOU, PROVIDE A COMPLETE ADDRESS
Apt./Unit Number
State/Province
Country
21K. DATE STEPCHILD LEFT VETERAN'S HOUSEHOLD (MM-DD-YYYY)
21L. FINANCIAL SUPPORT PROVIDED
SECTION VI: VETERAN/CLAIMANT REPORTING DEATH OF A DEPENDENT
22A. (1) DEPENDENT TYPE (Check all that apply)
MINOR CHILD UNDER 18 YEARS OLD
STEPCHILD
CHILD PERMANENTLY INCAPABLE OF SELF-SUPPORT
22B. NAME OF DEPENDENT (First, Middle Initial, Last)
22C. DATE OF DEATH (MM/DD/YYYY)

MonthDayYear
Date
22D. PLACE OF DEATH (City & State, County & State, or City & Country)
State/Province
Country
22A. (2) DEPENDENT TYPE (Check all that apply)
MINOR CHILD UNDER 18 YEARS OLD
CHILD PERMANENTLY INCAPABLE OF SELF-SUPPORT
18-23 YEARS OLD AND IN SCHOOL
22B. NAME OF DEPENDENT (First, Middle Initial, Last)
22C. DATE OF DEATH (MM/DD/YYYY)

MonthDayYear
Date
22D. PLACE OF DEATH (City & State, County & State, or City & Country)
State/Province
Country
SECTION VII: VETERAN/CLAIMANT REPORTING MARRIAGE OF CHILD
23A. NAME OF CHILD (First, Middle Initial, Last)
23B. DATE OF MARRIAGE (MM DD YYYY)

MonthDayYear
Date
SECTION VIII: VETERAN/CLAIMANT REPORTING A SCHOOLCHILD OVER 18 HAS STOPPED ATTENDING SCHOOL
24A. NAME OF SCHOOLCHILD (First, Middle Initial, Last)
24B. DATE SCHOOLCHILD STOPPED ATTENDING SCHOOL (MM DD YYYY)

MonthDayYear
Date
25. REMARKS (If any)
SECTION X: BENEFICIARYICLAIMANT'S CERTIFICATION AND SIGNATURE

(Note: Completion of this section is REQUIRED to process your request)

IMPORTANT: The primary purpose of this form is to gather information or statements that may result in a change to your VA benefits. By signing this form you have given permission to make benefit payment changes that could result in the creation of an overpayment. If such adverse actions are taken you will receive additional notification from VA regarding repayment options.

I HEREBY CERTIFY THAT the information I have given above is true and correct to the best of my knowledge and belief.
26A. SIGNATURE OF BENEFICIARYICLAIMANT OR ALTERNATE SIGNER* (REQUIRED)*

Clear
(FOR USE BY VA ONLY)
26B. DATE (MM/DD/YYYY)*

MonthDayYear
Date
*ALTERNATE SIGNER: By signing on behalf of the beneficiary/claimant, I certify that the claimant is: under the age of 18, mentally incompetent to provide substantially accurate information needed to complete the form or to certify that the statements made on the form are true and complete, or physically unable to sign the form

*ALTERNATE SIGNER: By signing on behalf of the beneficiary/claimant, I certify that I am: a court-appointed representative, a person who is responsible for the care of the claimant, to include but not limited to a spouse or other relative, or a manager or principal officer acting on behalf of an institution which is responsible for the care of the claimant.

an attorney in fact or agent authorized to act on behalf of the claimant under a durable power of attorney,

PENALTY: The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a materialfact,knowingit to be false, or for the fraudulent acceptance of any payment to which you are not entitled.

PRIVACY ACT INFORMATION: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title Codeof 38,Federal Regulations 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional communications, epidemiological or research studies, the collection of owedto the United States, litigation in which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification money of identityandstatus, and personnel administration) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Veteran Readiness and Records - VA, published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. Giving us your and your dependents' SSN Employment information accountis mandatory. Applicants are required to provide their SSN and the SSN of any dependents for whom benefits are claimed under Title 38 USC 5101 (c1 VA Thewillnotdeny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by Federal Statute of law in effect prior to January 1, 1975, and still in effect. Information that you furnish may be utilized in computer matching programs with other Federal or state agencies for the purposeofyour determining eligibilityto receive VA benefits, as well as to collect any amount owed to the United States by virtue of your participation in any benefit program administered by the Department of Veterans Affairs.

RESPONDENT BURDEN: We need this information to determine marital status and eligibility for an additional allowance for dependents under 38 U.S.C. 1115. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 30 minutes to review the instructions, find the informationandthis complete if ofinformation form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain. If desired,youcancall 1-800-827-1000 to get information on where to send comments or suggestions about this form.
SECTION XI: ADDITIONAL CHILD(REN) (Addendum) (Please submit this page with the completed application if you have additional children to add to your claim. If more space is needed, please make additional copies of this page to submit with your application
1A. NAME OF ADDITIONAL CHILD TO ADD (First, Middle Initial, Last)
1B. SOCIAL SECURITY NUMBER
1C. DATE OF BIRTH (MM DD YYYY)

MonthDayYear
Date
1D. PLACE OF BIRTH (Provide City and State, County and State, or City and Country)
Country
1E. IF THE CHILD DOES NOT LIVE WITH THE CLAIMANT PROVIDE NAME OF PERSON THE CHILD RESIDES WITH
1F. IF THE CHILD DOES NOT LIVE WITH THE CLAIMANT, PROVIDE COMPLETE PHYSICAL ADDRESS WHERE CHILD RESIDES
Country
1G. CHILD STATUS (Check all that apply) 18-23 YEARS OLD AND IN SCHOOL (If checked, fill out VA Form 21-674) CHILD PREVIOUSLY MARRIED (If checked, provide the date marriage ended and how the marriage ended in Item 1H)

CHILD PERMANENTLY INCAPABLE OF SELF-SUPPORT

STEPCHILD (If checked, complete Item 11)

1H. HOW AND WHEN MARRIAGE ENDED
DATE (MM-DD-YYYY)
11. IF YOU CHECKED "STEPCHILD" IN ITEM 1G, IS STEPCHILD THE BIOLOGICAL CHILD OF YOUR SPOUSE? DATE (MM-DD-YYYY)

YES (If "Yes," provide the date the child entered veteran's household)
2A. NAME OF ADDITIONAL CHILD TO ADD (First, Middle Initial, Last)
2B. SOCIAL SECURITY NUMBER
2C. DATE OF BIRTH (MM DD YYYY)

MonthDayYear
Date
2D. PLACE OF BIRTH (Provide City and State, County and State, or City and Country)
State/Province
Country
2E. IF THE CHILD DOES NOT LIVE WITH THE CLAIMANT PROVIDE NAME OF PERSON THE CHILD RESIDES WITH
2F. IF THE CHILD DOES NOT LIVE WITH THE CLAIMANT, PROVIDE COMPLETE PHYSICAL ADDRESS WHERE CHILD RESIDES
City
Country
2G. CHILD STATUS (Check all that apply)

18-23 YEARS OLD AND IN SCHOOL (If checked, fill out VA Form 21-674)

CHILD PERMANENTLY INCAPABLE OF SELF-SUPPORT

CHILD PREVIOUSLY MARRIED (If checked, provide the date marriage ended and how the marriage ended in Item 2H)

STEPCHILD (If checked, complete Item 2I)

2H. HOW AND WHEN MARRIAGE ENDED

21. IF YOU CHECKED "STEPCHILD" IN ITEM 2G, IS STEPCHILD THE BIOLOGICAL CHILD OF YOUR SPOUSE? DATE (MM-DD-YYYY)

YES (If "Yes," provide the date the child entered veteran's household)
Should be Empty:

ADD AND/OR REMOVE DEPENDENTS

SECTION I: VETERAN/CLAIMANT'S IDENTIFICATION INFORMATION

Section I Continued

Section I Continued

SECTION II: INFORMATION NEEDED TO ADD SPOUSE

TRIBAL

PROXY

(MM-DD-YYYY)

(MM-DD-YYYY)

(MM-DD-YYYY)

(MM-DD-YYYY)

(MM-DD-YYYY)

(MM-DD-YYYY)

(MM-DD-YYYY)

SECTION III: INFORMATION NEEDED TO ADD CHILD(REN)

BIOLOGICAL

CHILD PERMANENTLY INCAPABLE OF SELF-SUPPORT

DATE (MM-DD-YYYY)

CHILD PERMANENTLY INCAPABLE OF SELF-SUPPORT

DATE (MM-DD-YYYY)

BIOLOGICAL

ADOPTED

CHILD PERMANENTLY INCAPABLE OF SELF-SUPPORT

DATE (MM-DD-YYYY)

CHILD PERMANENTLY INCAPABLE OF SELF-SUPPORT

SECTION IV: VETERAN REPORTING DIVORCE FROM FORMER SPOUSE

SECTION V: VETERAN/CLAIMANT REPORTING ON STEPCHILD(REN)

SECTION VI: VETERAN/CLAIMANT REPORTING DEATH OF A DEPENDENT

MINOR CHILD UNDER 18 YEARS OLD

STEPCHILD

MINOR CHILD UNDER 18 YEARS OLD

18-23 YEARS OLD AND IN SCHOOL

SECTION VII: VETERAN/CLAIMANT REPORTING MARRIAGE OF CHILD

SECTION VIII: VETERAN/CLAIMANT REPORTING A SCHOOLCHILD OVER 18 HAS STOPPED ATTENDING SCHOOL

DATE (MM-DD-YYYY)